"I'll Sleep When I'm Dead," Right? You Might Get There Sooner Than You Think
Could just one night of insufficient sleep actually kill somebody?
Consider this: Research at the Harvard School of Public Health found that staying awake for 24 consecutive hours can increase your chances of a car accident by 168%, and your risk of a near miss by 460%.[1] (The general risk of having a car accident in the U.S. is roughly 3.50%.[*])
In fact, Charles A. Czeisler, Baldino Professor of Sleep Medicine at Harvard Medical School and global sleep expert, informs us that “every hour someone is killed in a drowsy-related crash.”[2]
That was in 2007. We now know, thanks to 2013 findings, that fatigue causes up to 20% of all car crashes.[3] And that's just a conservative estimate.
We are so sensitive to reduced sleep that, as one study showed, losing just 1 hour from daylight savings time in the spring immediately increased the average rate of traffic accidents by 8%, whereas the fall time-shift resulted in an immediate decrease in accidents of roughly the same magnitude.[4]
BUT, IF A CAR CRASH DOESN'T KILL YOU, SEEING THE DOCTOR MIGHT:
In a U.S. survey of 2,700 physicians-in-training who had worked for 24 hours straight, 1 out of 5 reported making a fatigue-related mistake that had injured a patient, and 1 out of 20 reported making a fatigue-related mistake that had resulted in the death of a patient.[5] Medical errors are so prevalent, we've got comic strips about them.
According to Dr. Czeisler, "we now know that 24 hours without sleep or a week of sleeping four or five hours a night induces an impairment equivalent to a blood alcohol level of .10%,”[6] which qualifies as legally drunk.
I can’t help but see a connection between this information on sleep and the fact that, every year, 15 million medical incidents occur that harm a patient,[7] and 210,000 - 440,000 annual deaths are associated with preventable harm in hospitals.[8]
That makes medical errors the third leading cause of death in America, just behind heart disease and cancer.[9]
Put in other terms…“That means hospitals are killing off the equivalent of the entire population of Atlanta one year, Miami the next, then moving to Oakland, and on and on.”[10] – Leah Binder, Forbes Contributor
Why is this happening? The fact that most medical practitioners are sleep deprived and over-worked likely has something to do with it.
We all know that people working in the medical field-- from student residents to surgeons-- are assigned long consecutive hours that are destructive to the health of any human being, which is ironic given that their occupation is supposed to be about protecting health (just not their own, it seems). Not only are these sleep-depriving work standards causing harm to the people being treated, but sleep deprivation has even been used as a form of torture, so how appropriate is it for any profession to force people to be sleep deprived by its very design? The fact that the medical field still functions by these standards, despite evidence showing that it harms the performance of the practitioners and the lives of their patients, is unacceptable.
Consider what these sleep findings suggest for other intrinsically hazardous occupations and for our daily performance in general. People in all sorts of jobs are making mistakes that can physically harm someone because they're sleep deprived-- from nurses to sandwich makers (i.e. sanitation). I definitely don't want a sleep deprived dentist anywhere near my mouth, or a drowsy taxi driver picking me up. And I don't want a consultant making bad recommendations for my business because they're too tired to think well-- not as a result of any personal weakness or failure, but as a natural human response to unhealthy work conditions.
So, why does sleep loss make us prone to having all sorts of accidents that could harm or even kill us?
Turns out, our bodies are so sensitive to insufficient sleep that biochemical and neural changes happen even with mild levels of sleep deprivation. Sleep is when all sorts of physiological processes occur that are critical for maintaining our physical and cognitive health. It's when memories are consolidated and the most salient information is picked out and stored, toxins are flushed out of our brains that could otherwise cause degenerative disorders, and the proper balance of hormonal levels is maintained (hormones regulate various bodily processes, so if our hormonal levels are out of whack, so is our health)-- these are just a few of the many things that occur when we sleep. One night of reduced sleep disturbs these processes, causing us to be less alert and precise, and more likely to make a mistake-- from typos to cutting ourselves or crashing into another car.
As you can see, sleep is not a passive, "criminal waste of time"--sorry, Edison (not sorry)-- it's actually extremely important for optimizing your waking hours and, for those who are interested, to staying alive-- at least long enough to finish that super important project.
But, problem is, we live in a "culture where not sleeping very much or pulling an all-nighter is considered a badge of honor,'" says Safwan Badr, a sleep expert with Detroit Medical Center and Wayne State University.
"We would never say, 'This person is a great worker! He’s drunk all the time!' yet we continue to celebrate people who sacrifice sleep. The analogy to drunkenness is real because, like a drunk, a person who is sleep deprived has no idea how functionally impaired he or she truly is. Moreover, their efficiency at work will suffer substantially, contributing to the phenomenon of 'presenteeism,' which...exacts a large economic toll on business," commented Dr. Czeisler in an HBR interview discussing the responsibility of company executives to "take sleeplessness seriously."
So, apart from all the diseases caused by chronic sleep deprivation, just one night of insufficient sleep impairs our cognitive performance enough to potentially result in serious, life-altering (or even life-ending) accidents.
What Can We Do?
1. What doesn't get scheduled, doesn't get done. Schedule an 8-hour window from the time you turn your lights off to the minute your alarm goes off.
2. At least an hour before you plan to sleep, dim the lights and stay off of technology (that includes your phones). The blue light from these devices inhibits the release of melatonin, a hormone that helps regulate sleep. This keeps you up longer.
3. Use blue light filters on all your screens in the evenings. The earlier you avoid blue light in the evenings, the better for your sleep. I like to use f.lux for my computer and Blue Light Filter on my android.
4. We need an entire culture shift. Too many jobs set long consecutive hours that make us accident-prone, and too many jobs burn the candle at both ends, leaving a window of less than 8 hours for sleep, like consultants who take the red-eye flight and go straight into meetings when they land early in the morning, to restaurant workers who close late and open early, to nurses who work long, consecutive hours into the night.
The culture shift is going to be a long and arduous process, like any social movement that came before it, but it can happen-- the women's rights and civil rights movements would have never achieved the crucial progress that they did had people thrown their hands up and sighed, "It's too hard." People spoke up and fought for what they believed in, and that's what needs to happen now. Leaders need to pay attention and apply these new findings to the working conditions they put in place, and employees need to push for change by spreading the word and standing up for work conditions that optimize-- rather than undermine-- their performance.
Footnotes
[*] Risk was calculated by U.S. Census data on annual motor vehicle accidents in 2009 (the most recent data available), and 2009 U.S. Census data on population
References
[1] Czeisler, CA. Sleep deficit: the performance killer. A conversation with Harvard Medical School Professor Charles A. Czeisler. Harvard Business Review. 2006 Oct;84(10):53-9, 148. http://www.ncbi.nlm.nih.gov/pubmed/17040040. (Full Article: http://hbr.org/2006/10/sleep-deficit-the-performance-killer.)
[2] "Why Sleep Matters." Healthy Sleep. Harvard Medical School. Accessed Aug 2014: http://healthysleep.med.harvard.edu/video/sleep07_matters/qt-hi
[3] Trulove, Susan. "Driver Fatigue Causes 20% of Auto Crashes: Study." Insurance Journal. 15 April 2013. Web. Accessed 27 Sept 2014: http://www.insurancejournal.com/news/national/2013/04/15/288377.htm
[4] Coren S. Daylight Savings Time and Traffic Accidents. N Engl J Med. 1996; 334:924-925. www.nejm.org/doi/full/10.1056/NEJM199604043341416
[5] "Why Sleep Matters." Healthy Sleep. Harvard Medical School. [Video] Accessed Aug 2014: http://healthysleep.med.harvard.edu/video/sleep07_matters/qt-hi
[6] Czeisler, CA. Sleep deficit: the performance killer. A conversation with Harvard Medical School Professor Charles A. Czeisler. Harvard Business Review. 2006 Oct;84(10):53-9, 148. http://www.ncbi.nlm.nih.gov/pubmed/17040040. (Full Article: http://hbr.org/2006/10/sleep-deficit-the-performance-killer.)
[7] Medical Negligence: The Role of America’s Civil Justice System in Protecting Patients’ Rights. American Association for Justice. Feb 2011. www.justice.org/sites/default/files/Medical_Negligence_Primer3.pdf
[8] James, John T. A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care. Journal of Patient Safety. 2013;9(3):122-128.
http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx
[9] "FastStats: Leading causes of death." Center for Disease Control and Prevention. 14 July 2014. Web. Accessed Sept 2014: http://www.cdc.gov/nchs/fastats/lcod.htm
[10] Binder, Leah. "Stunning News On Preventable Deaths In Hospitals." Forbes. 23 Sept 2013. Web. Accessed Sept 2014: http://www.forbes.com/sites/leahbinder/2013/09/23/stunning-news-on-preventable-deaths-in-hospitals/
